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Case Reports
. 2000 May 4;118(3):78-80.
doi: 10.1590/s1516-31802000000300006.

Lead poisoning after gunshot wound

P R de Madureira  1 , E M De Capitani, R J Vieira
Affiliations
Case Reports

Lead poisoning after gunshot wound

P R de Madureira et al. Sao Paulo Med J. .

Abstract
in English, Portuguese

Context: Despite the absence of symptoms in the majority of patients carrying lead bullet fragments in their bodies, there needs to be an awareness of the possible signs and symptoms of lead intoxication when bullets are lodged in large joints like knees, hips and shoulders. Such patients merit closer follow-up, and even surgical procedure for removing the fragments.

Objective: To describe a patient who developed clinical lead intoxication several years after a gunshot wound.

Design: Case report.

Case report: A single white 23-year-old male, regular job as a bricklayer, with a history of chronic alcohol abuse, showed up at the emergency department complaining of abdominal pain with colic, weakness, vomiting and diarrhea with black feces. All the symptoms had a duration of two to three weeks, and had been recurrent for the last two years, with calming during interval periods of two to three weeks. Abdominal radiograms showed a bullet lodged in the left hip, with a neat bursogram of the whole synovial capsule. A course of chelating treatment using calcium versenate (EDTACaNa2) intravenously was started. After the chelation therapy the patient had recurrence of his symptoms and a radical solution for the chronic mobilization of lead was considered. A hip arthroplasty procedure was performed, leading to complete substitution of the left hip.

CONTEXTO:: Apesar da ausência de sintomas na maioria das pessoas que albergam projéteis ou fragmentos de projéteis de arma de fogo em alguma parte do corpo devido a acidentes passados, a ocorrência de sinais e sintomas de intoxicação por chumbo pode ser freqüente em pacientes onde o projétil está alojado em grandes articulações como joelho, quadril e ombros, merecendo maiores cuidados de seguimento clínico e procedimentos cirúrgicos de retirada.

OBJETIVO:: Descrever un doente que desenvolveu intoxicação por chumbo vários anos após um ferimento por arma de fogo.

TIPO DE ESTUDO:: Relato de caso.

RELATO DE CASO:: Um homem, 23 anos, branco, pedreiro, com história de uso abusivo de bebidas alcoólicas, foi atendido no prontosocorro com dor abdominal intensa em cólica, fraqueza, vômitos e diarréia com fezes escurecidas. Todos os sintomas tinham a duração de duas a três semanas, tendo sido recorrentes nos últimos dois anos, com períodos de acalmia de duas a três semanas. Radiografia de abdôme mostrou um projétil incrustrado na articulação femoral esquerda, com imagem tipo "bursograma" comprometendo toda a cápsula sinovial. Tratamento quelante usandoversenato de cálcio (EDTA CaNa2) endovenoso foi então iniciado. Após a terapia quelante, o paciente teve recorrência dos sintomas devido a remobilização do chumbo dos tecidos teciduais. a artroplastia da articulação foi realizada como forma de solução definitiva do problema.

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Conflict of interest statement

Conflict of interest: Not declared

Figures

Figure
Figure. Radiograph of the left hip showing a fragment of the bullet and bursogram.
See this image and copyright information in PMC

References

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